Expanded Disease Management Techniques

BMI is testing Out-of-the-Box techniques including Holistic treatment of Chronic Kidney Disease. When paired with creative benefit limits for Dialysis, BMI clients are spared from extremely high dialysis costs and increased exposure from Reinsurance lasers.

Disease Management

Diabetic and Heart Disease patients are being positioned for greater cost-containment and improved patient health. BMI is testing home monitoring equipment on our own employees at work to evaluate ease of use and effectiveness. Client companies are invited to stop by to see and use the monitoring system for blood pressure, blood sugar, weight, etc. which is monitored telephonically by expert disease managers.

More Audit Findings

BMI claims examiners and nurse reviewers are continually identifying trends in healthcare and costs. Recently, we are discovering a high error rate on the billing of intensive care rooms when intensive care was not delivered. Another new problem area is the extended observation time beyond 24 hours without classifying the patient as an inpatient. Patients actually go to a regular semiprivate room but are billed as outpatients, and at a higher hourly rate than inpatients.

Surgery Centers

Outpatient Surgery Centers now play a bigger part in patient care, but they can adversely affect Plan expenses. BMI is carefully reviewing these charges, especially when the center has physician ownership. We have denied up to 90 percent of the bill for exceeding Reasonable & Customary on some claims and we are counseling covered members about the potential for extra, unexpected out-of-pocket exposure.